Prostate Anatomy,physiology & Pathology

3. Prostate……..
Anatomy
Surface , Lobes, Relations
Size, weight
Physiology
Functions, PSA
Pathology
BPH
Prostatitis(Acute & Chronic)
Prostatic Abscess
BOO
CA Prostate

4. Definition :
Prostate is a fibromuculoglndular structure situated between the neck of
the bladder and external urethral sphincter and surround the prostatic urethra, it is
conical in shape
It has 3 surfaces
1. Anterior
2. posterior
3. Two inferio-lateral
it has 5 lobes
1.Anterior
2.Posterior
3.Median
4.Two Lateral

5. About 3cm vertically , 4cm Transversally at base and about
2cm antero-posteriorly.
15-20 gm
Adenoma usually occurs in medial and lateral lobes, it never occurs in
ant & pos lobe because they are mainly of fibromuscular tissue &
devoid of glandular structures

6. Parts of prostate

10. The prostate is related to the two capsules and one fascia behind
1. True Capsule
Formed by the condensation of the prostate at periphery
2. False Capsule
Formed by the visceral layer by the pelvic fascias
(The prostatic venous plexus lies between these capsules)
3. Surgical Capsule
Formed by the non adenomatous tissue of the prostate which
is pushed by the hypertrophied gland to the periphery
Fascia Behind the Prostate
it is also known as rectovesical, prostatoperitonial,denivillier’s fascia

11. inside and around the prostate
Urethra is divided into three parts
1. Prostatic urethra(Widest and most dilatable part)
2. Membranous urethra (Shortest and least dilatable part)
3. Spongy Urethra
A. Internal Sphincter(Sphincter Vesicae) at the neck of Bladder
B. External Sphincter or sphincter urethrae

12. Neck of Bladder
External Urethral sphincter
Danovillir’s fascia
Levator ani
Internal Iliac artery(Inferior Vesical and middle rectal arteries)
: Same as via posterior venous plexus but some drainage also
occurs valve less vertebral plexus which is responsible for haematogenous
spread of Ca of prostate to the bones of vertebra etc
Internal Iliac Lymph Node

13. 1. The testicular hormone regulate the prostate, Testosterone is
secreted by leydig cells of the testes, in the absence of the both
testis (Testicular hormones) the prostate fails to develop.
2. The prostate secrete the specific fluid (Prostatic fluid( which
provide 10-20% volume of ejaculation, it contains the
prostaglandin enzymes and acid phosphates, it has anti bacterial
property which helps to prevent UTI.
3. Prostate also secretes a glycoproteinous fluid which is known as
PSA, The PSA actually liquefies the semen and allows the sperm
to swim freely, and it is the best tumor marker for Ca prostate

14. Less than 4 nmol/ml Normal
4-8 nmol/ml BPH
9-10 nmol/ml Diagnostic for BPH & suggestible for CA
More than 10 mol/ml Suggestive for CA Prostate

16. Benign prostatic hyperplasia is the histological pattern of the
prostate, characterized by proliferation of smooth muscle and epithelial
cells within the prostatic transition zone. This may lead to prostatic
enlargement.
It is considered a normal part of aging in men and is hormonally
dependent on testosterone and DHT production.
50% of men develop BPH by age 60 years and 90% by age 85 years.

17. It is involuntary hyperplasia due to disturbance of the ratio and quantity
of circulating androgens and estrogens.
BPH is a benign neoplasm, also called as fibromyoadenoma.
With age TS level drops slowly. But fall of oestrogen level is not equal.
So prostate enlarges through intermediate peptide growth factor.
BPH arises from submucosal glands of periurethral transitional zone
with stromal proliferation and adenosis. It eventually compresses the
peripheral zone and enlarges as lateral lobe.
BPH arising from subcervical glands of central zone enlarges as middle
lobe projecting up into the bladder.

19. International prostate symptom score
1-7 = mild 8-19 = moderate 20-35 = severe

21. 1. Size- upper pole is easily reached/with difficulty/not reachable.
2. Consistency- Rubber/soft/firm/hard.
3. Rectal mucosa- Gliding/fixed
4. Surface- Smooth/nodular.
5. Tenderness- Absent/Present
6. Median Sulcus- Prominent/palpable/obliterated

22. Grade I---Upper pole easily reachable
Grade II---Upper pole reachable with difficulty
Grade III--- Can’t be reachable
Normal Weight --------18-20 gm
Grade I up to --------upto 25gm
Grade II upto --------upto 50gm
Grade III upto --------upto 70gm
Grade IVupto --------upto 80 gm
Grade V upto -------->80 gm

24. Changes in the urethra:
Enlargement of the prostatic urethra
Exaggeration of the normal posterior curvature of the prostatic urethra
Urethra compressed laterally reducing it to an A-P slit
Changes in the urinary Bladder:
Compensatory hypertrophy of the vesical detrussor
Trabeculation of bladder wall.
Hypertrophy of the trigone.
Formation of diverticula
Formation of pool of residual urine- cystitis,calculus
Changes in ureters and kidney:
Hydroureter and Hydronephrosis
Vesicoureteric reflux- Ac. & Chr. Pyelonephritis

27. Types
Acute or chronic.
Causes:
 Due to instrumentation.
 Ascending infection from below.
 Haematogenous.
 Descending infection from above.
Bacteria involved:
E. coli, Klebsiella, Proteus.
Staphylococcus.
Streptococcus faecalis.
Gonococcus

28. Pain, frequency, fever with chills and rigors.
Retention of urine.
Perineal heaviness, pain on defaecation.
Tender prostate on per rectal examination.
Initial fraction of urine is turbid which is sent for culture
and sensitivity.

29. Caused by E. coli, Staphylococcus, Streptococcus, Trichomonas,Chlamydia.
 There is always associated posterior urethritis.
Epididymitis.
 Pain in the perineum, rectum, low back pain, leg pain.
 Fever.
 Sexual dysfunction.
 Per rectal examination shows tender prostate.
 Prostatic fl uid obtained by prostatic massage shows 15 or more pus cells/HPF.

30.  It is infection, suppuration and pus formation in the prostate gland.
 Presentation is fever, rigors, perineal pain, urinary disturbances, and
tender
Soft fluctuant swelling in the prostate onrectal examination.
 Often presentation may be retention of urine.
 Total count will be increased.
 Urine will show pus cells.
 US is diagnostic. US is often done over perineum also.
 Treatment is antibiotics; US guided aspiration transperineally in
lithotomy position or transperineal incision and drainage.
 Suprapubic cystostomy is better in case of retention of urine.
 After drainage antibiotics are needed for longer period of 6 weeks to
prevent recurrent infection.

31.  It is low urinary flow rate with the presence of high voiding pressure.
It is an urodynamically confirmed entity.
 It is diagnosed by urodynamic pressure flow study.
 Flow rate will be les than 10 ml/second with voiding pressure more
than 80 cm of water.
 Eventually detrusor inefficiency occurs causing significant residual
urine.

32. —BPH; bladder neck hypertrophy or stenosis; carcinoma
of prostate; urethral stricture; functional bladder neck obstruction.
—acute retention of urine; chronic retention of urine;
impaired bladder emptying; uraemia; infection; stone formation,
haematuria.
US; renal function tests; IVU; PSA are the investigations.
Management is by treating the cause by cystoscopic bladder
neck incision, urethrotomy; TURP, etc.

33. It is the most common malignant tumour in men over 65 years.
Carcinoma prostate occurs in peripheral zone in prostatic gland
proper, i.e. commonly in posterior lobe. So prostatectomy for BPH
does not confer protection against development of carcinoma prostate.
Incidence of prostate cancer in men over 80 years is 70%.

34. Microscopically latent
 Tumours incidentally found either by TURP or by PSA estimation
 Early localised carcinoma
 Advanced local prostatic carcinoma
 Metastatic carcinoma either into the bone commonly or other
organs
Histology: It is an adenocarcinoma, wherein there is loss of myoepithelial cell layer
which normally surrounds the prostatic glands (Gleason). Glands here appear in
confluence. Grading of carcinoma is based on dedifferentiation as proposed by
Gleason.

35. Occult—Diagnosed after investigation due to sus picion
Stage I—Tumour confi ned to prostate/local nodule
Stage II—Tumour involving capsule or diffuse type
Stage III—Tumour involving seminal vesicle
Stage IV—Extension into adjacent tissue
Staging of Ca prostate (A) Occult, (B) Stage I, (C) Stage II, (D) Stage III, (E) Stage IV.
A
ED
CB